Parkinson’s Disease

Parkinson’s disease is a disorder of the brain that leads to shaking and difficulty in movement and in-coordination. Parkinson’s disease most often develops after age 50. It is one of the most common nervous system disorders of the elderly.

Causes of Parkinson’s disease

Impaired release of dopamine

  1. Idiopathic
  2. Drugs depleting dopamines stores(reserpine, tetrabenazine)
  3. Toxins damaging dopaminergic neurons
  4. Viral infections (Encephalitis lethargica, Japanese B encephalitis)
  5. Trauma (Repeated head injuries )

Blockade of striatal dopamine receptors

  1. Phenothiazines
  2. Butyrophenones

Damage to striatal neurons

  1. Viral infection
  2. Multi-system atrophy

Miscellaneous

  1. Wilson’s disease
  2. Huntington’s disease
  3. Cerebral tumour
  4. Neurosyphilis

Symptoms and signs

General

  • Expressionless face(mask-like appearance)
  • Greasy skin
  • Soft, rapid, indistinct speech
  • Flexed posture

Specific

Gait

  1. Slow to start walking
  2. Shortened stride
  3. Rapid small steps, tendency to run
  4. Reduced arm swinging
  5. Impaired balance on turning

Tremors

Resting

  1. Usually first in fingers/thumb
  2. Coarse, complex movements, flexion/extension of fingers
  3. Abduction/adduction of the thumb
  4. Supination/pronation of forearm
  5. May affect arms, legs, feet, jaw, tongue
  6. Intermittent, resting, on distracted
  7. Diminishes on action

    Postural

  1. Less obvious, faster, finer amplitude
  2. Present on action or posture persists with movement

Rigidity

  1. Cogwheel type, mostly upper limbs, phasic element to stiffness in all directions of movements
  2. Plastic (lead pipe)type, mostly legs and trunk
  3. Trunk flexed, stooped posture

Hypokinesis

  1. Slowness initiating movements
  2. Impaired fine movements, especially fingers(micrographic
  3. Poor precision of repetitive movements

Psychic

  1. Anxiety
  2. confusion
  3. constipation
  4. dementia
  5. difficulty swallowing
  6. excessive salivation
  7. a diminished sense of smell
  8. increased sweating
  9. Insecurity
  10. male erectile dysfunction
  11. stress
  12. urinary frequency/urgency

Investigations

  • Serological tests for syphilis
  • SPECT (single photon emission computed tomography) scan
  • MRI scan

Treatment

  • Ayurvedic Medicines
  • Lifestyle changes-
  1. Good nutrition
  2. Suitable exercise
  3. Regular rest periods and avoiding stress
  4. Physical therapy, speech therapy, and occupational therapy
  5. Railings or bannisters placed in commonly used areas of the house
  6. Special eating utensils
  • Surgery

Complications

  • Disability (differs from person to person)
  • Injuries from falls
  • Pneumonia (from aspirating saliva)

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